PREVALENCE AND NATURAL-HISTORY OF HEPATITIS-C INFECTION IN PATIENTS CURED OF CHILDHOOD LEUKEMIA

The aim of this study was to ascertain prevalence and natural history of hepatitis C virus (HCV) infection in a large cohort of patients cur ed of childhood leukemia who had been followed prospectively for liver disease for at least 10 years since chemotherapy withdrawal: 114 cons ecutive patients entered the study. Liver function tests and ultrasono graphy were used to assess presence of liver disease. Patients were te sted for antibody to HCV and for serum HCV-RNA at the end of chemother apy and at the end of follow-up. At chemotherapy withdrawal, 56 patien ts (49%) were HCV-RNA positive, often without detectable anti-HCV, and in these cases, transaminase levels were more elevated during (P = .0 8) and after (P = .04) chemotherapy compared with HCV-RNA negative cas es. Patients were then followed-up 13 to 27 years (mean, 17) after che motherapy withdrawal. During this period, 38 initially anti-HCV negati ve patients seroconverted to anti-HCV and 17 initially anti-HCV positi ve cases lost reactivity. Forty patients were persistently HCV-RNA pos itive in serum, while 16 initially viremic patients became HCV-RNA neg ative during follow up. At the end of the observation period, a persis tent transaminase elevation was detected only in four HCV-RNA positive and anti-HCV positive cases, while no patient developed signs or symp toms of decompensated liver disease. Thus, hepatitis C was a frequent finding in long-term survivors after chemotherapy. It was associated w ith an atypical serologic profile and did not cause severe liver impai rment over a period of 13 to 27 years. (C) 1997 by The American Societ y of Hematology.